Effectiveness and safety of telemonitoring compared with standard of care in people with type 2 diabetes treated with insulin: a national multicenter randomized controlled trial

BACKGROUND: Telemonitoring interventions facilitating adjustments in medication may improve glycemic control more effectively. Hence, the aim of this randomized controlled trial was to explore the effectiveness and safety of telemonitoring compared with standard of care in people with type 2 diabetes (T2D) on insulin therapy.

METHODS: The trial was a Danish multicenter open-label randomized controlled trial with a threemonth trial period. People with T2D on insulin therapy were randomized (1:1) to telemonitoring (intervention) or standard of care (control) based on the EASD/ADA consensus report. The telemonitoring group used a continuous glucose monitor (CGM), a connected insulin pen, an activity tracker, and smartphone applications throughout the trial period. Hospital staff monitored the telemonitoring groups' data and contacted the participants by telephone repeatedly. The primary endpoint was change from baseline in CGM time in range (3·9-10·0 mmol/L) three months after randomization. An analysis of covariance was used to assess the difference in change from baseline between the telemonitoring and standard of care group.

FINDINGS: In total, 331 participants were included and randomized (telemonitoring: 166; standard of care: 165). The observed treatment difference in change from baseline in CGM-TIR was 6·8 % (CI: 4·8, 8·8), and the estimated treatment difference was 13·6 % (CI: 7·2, 20·0) (p = 0·004) in favor of telemonitoring.

INTERPRETATION: The trial demonstrated that telemonitoring is superior to standard of care in T2D for improving glycemic control.

FUNDING: The trial was supported by The Innovation Fund Denmark, Novo Nordisk A/S, and Dexcom, Inc.